Healthcare Provider Details

I. General information

NPI: 1962137307
Provider Name (Legal Business Name): SUZANNE STERN-BRANT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 TULANE DR. SE SUITE C
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

202 TULANE DR. SE SUITE C
ALBUQUERQUE NM
87106
US

V. Phone/Fax

Practice location:
  • Phone: 505-615-1586
  • Fax: 505-232-5335
Mailing address:
  • Phone: 505-615-1586
  • Fax: 505-232-5335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-12085
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: